The causes of rheumatoid arthritis (RA) and most autoimmune diseases are unknown. This includes celiac, type 1 diabetes, lupus, multiple sclerosis, and ulcerative colitis. That’s a sad thing since these diseases are insidious.
Because of the lack of definitive information about these diseases, there are many speculations running wild around the internet and unsuspecting sufferers look for answers from any place they can find it. I was recently eating in a restaurant and the TV on the wall was running a product infomercial and there was a claim at the bottom of the screen…”Arthritis can be cured”. One of my friends pointed and said, “Look, you better check it out!” Of course, at the bottom of the product’s website is this fine print *The statements on this page have not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
Since being diagnosed with rheumatoid arthritis, my curiosity and scientific training pushed me deep into the research literature. By far the best work I’ve found is from Alessio Fasano from the University of Maryland School of Medicine. He has an excellent article called “Surprises from Celiac Disease” in the August 2009 issue of Scientific American (you have to suscribe to read it but here is a link to story about the article).
While most of Fasano’s research is with celiac disease (a problem digesting the gluten protein in wheat), his work is beginning to shed light on other autoimmune diseases. He notes that a trio of triggers seems to be present. 1. an environmental trigger, 2. a genetic susceptibility, and 3. a “leaky gut”.
With rheumatoid arthritis, scientists has long suspected that an infection of some sort, an environmental trigger, sets off the immune system. That’s why some of the early medicines, like sulphasalazine, were derived from antibiotics. Some still advocate long term antibiotic therapy for RA (check out the Roadback website). But infectious triggers have never been pinpointed nor fully explained the causes of the disease.
Genetics also seem to be connected. Many people suffering from autoimmune diseases show a genetic marker for some type of histocompatibility leukocyte antigen (HLA). HLA proteins bind to objects that they mistakenly recognize as foreign in the body. This sets off an immune response where T lymphocytes recognize the “foreign object”, call in reinforcements, and the immune system then fights the “invaders.” During this process powerful inflammatory chemicals called cytokines are released. These cause the symptoms of RA. Cytokine receptors, like tumor necrosis factor (TNF), have been the target of RA research for the past 20 years and resulted in powerful drugs like Enbrel. I’m very thankful that scientists figured this much out because I’m a recipient of their hard work. Enbrel seems to be working well for me thus far. A detailed description of the process can be found at Johns Hopkin’s.
This leads us to the third factor in the trio of triggers – the “leaky gut”. This one has been getting airplay in the internet for some time and I was suspicious when I first heard about it. It does sound rather weird. Up to 2/3 of the immune system lies around the intestines. That makes sense because we ingest so many things into our bodies through our mouths. Our defense system must be ready to combat invaders. The intestines normally have a tight wall that keeps particles from leaking into the rest of the body. Fasano’s work with celiacs is shedding light on how increased permeability of the intestines allows proteins to leak out into the body where they are immediately attacked by the immune system. The role of this in RA is speculative at this point but some relief has been found in some people by controlling their diet (milk and wheat proteins being the most common).
There are many more questions than answers right now. A quote from the editors about Fasano’s article sums it up, “Surprisingly, essentially the same trio …seems to underlie other autoimmune disorders as well. This finding raises the possibility that new treatments for CD (celiacs) may also ameliorate other conditions.” This gives me hope. Perhaps not for me directly since new and complicated medicines take many years to develop, test, and market. But I have hope for the millions of future sufferers of autoimmune disorders.